Service des maladies infectieuses et tropicales, Hospices Civils de Lyon, 69004 Lyon, France; Centre International de Recherche en Infectiologie, Inserm, U1111, Université Claude-Bernard Lyon 1, CNRS, UMR5308, École Normale Supérieure de Lyon, Univ Lyon, 69007, Lyon, France; Université Claude-Bernard Lyon 1, 69008 Lyon, France.
Inserm, CIC 1417, F-CRIN, Innovative clinical research network in vaccinology (I-REIVAC), 75014 Paris, France; Université de Paris, 75014 Paris, France; Assistance Publique-Hôpitaux de Paris, CIC Cochin Pasteur, Hôpital Cochin Paris, 75014 Paris, France.
Clin Res Hepatol Gastroenterol. 2020 Apr;44(2):126-134. doi: 10.1016/j.clinre.2019.08.007. Epub 2019 Oct 10.
In patients with chronic liver disease and liver transplant recipients, cirrhosis-associated immune dysfunction syndrome and immunosuppressant drug regimens required to prevent graft rejection lead to a high risk of severe infections, associated with acute liver decompensation, graft loss and increased mortality. In addition to maintain their global health status, vaccination represents a major preventive measure against specific infectious risks of particular concern in this population, such as invasive pneumococcal diseases, influenza or viral hepatitis A and B. However, immunization in this setting raises several issues: i) recommended vaccination schedules rely on sparse immunogenicity data without clinical efficacy and effectiveness trials designed for this specific population; ii) dynamics of immunosuppression makes timing of immunization challenging; iii) live attenuated vaccines are contraindicated after transplantation; and iv) vaccines tolerance is poorly known in cirrhotic patients. This review outlines the rational for vaccination in adult liver transplant candidates and recipients and available data regarding immunization in this specific population.
在慢性肝病患者和肝移植受者中，与肝硬化相关的免疫功能障碍综合征和预防移植物排斥反应所需的免疫抑制剂治疗方案导致严重感染的风险很高，这与急性肝功能失代偿、移植物丢失和死亡率增加有关。除了维持整体健康状况外，疫苗接种是预防该人群特别关注的特定传染性风险的主要预防措施，例如侵袭性肺炎球菌病、流感或甲型和乙型病毒性肝炎。然而，在这种情况下进行免疫接种引发了几个问题：i）推荐的疫苗接种计划依赖于针对该特定人群设计的缺乏临床疗效和有效性试验的稀疏免疫原性数据；ii）免疫抑制的动态变化使得疫苗接种的时间安排具有挑战性；iii）活减毒疫苗在移植后被禁用；iv）肝硬化患者对疫苗的耐受性知之甚少。这篇综述概述了在成年肝移植候选者和受者中进行疫苗接种的合理性，以及针对该特定人群的免疫接种的现有数据。
